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Claim by CenturyLink THE CITY OF DUB E MEMORANDUM Masterpiece on the Mississippi 1 I� TRACEY STECKLEIN .y PARALEGAL To: Mayor Roy D. Buol and Members of the City Council DATE: October 17, 2016 RE: Claim Against the City of Dubuque by CenturyLink Claimant Date of Claim Date of Loss Nature of Claim CenturyLink 10/17/16 08/12/16 Property Damage This is a claim in which claimant alleges that its buried CenturyLink cable was cut when the City of Dubuque was performing street excavation near the intersection of Olde y County Lane and Spring Valley Road.. ! This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa Communities Assurance Pool. cc: Michael C. Van Milligen, City Manager John Klostermann, Public Works Director CenturyLink OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TELEPHONE (563)583-4113/FAx (563)583-1040/EMAIL tsteckle@cityofdubuque.org CLAIM AGAINST THE CITY OF DUBUQUE, IOWA This written report constitutes your claim against the City of Dubuque, Iowa. You should complete this form in full and attach any additional information that supports your claim. The Maim must be filed with the City Clerk at City Hall, 50 W. 13th St., Dubuque, IA 52401. It will thea be referred by the City Council to the appropriate department for investigation. Once that investigation is completed, a report and recommendation will be submitted to the City Council. You will be provided with a copy of that report and recommendation. THE FINAL DECISION ON ALL CLAIMS IS MADE BY THE CITY COUNCIL, NO EMPLOYEE OF THE CITY OF DUBUQUE HAS THE AUTHORITY TO MADE ANY REPRESENTATION TO YOU AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID. 1. Name of Claimant: 2. Address: ! . s 3. Telephone Number: r0p- 3 a 1- z1rs-J 4. Date of Incident: �,�- 5. Time of Incident: 6. Location of Incident (Be specific); Ql9e. Caz, y if 7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give full details upon which you base your claim. if a City employee was Involved, give the employee's name.) The C—c l z. 4 h Q L ^w� ( ll.F'. h4.-Sri �.v'c. yq...� e k E 8. What were weather conditions like? 9. Give name and address of any witnesses: 14. Did police investigate? (if so, give names of officers.) f i 11. Was anyone injured? (If so, give names, addresses,and extent of injuries). r i 12. Was any damage done to property? (if so, describe property and the extent of damages. Attach estimates of damages or describe basis for ascertaining extent of damage.) 1 . What other damages do you claim, if any? //c-- 14. Have you been compensated for any part or all of your claim by any insurance company? (if so, give name and address of insurance company and amount paid.) � t 1v. What amount do you claim from the City of Dubuque? 16. 'Why do you claim the City of Dubuque is responsible? -FLe 17. Have you made any claim against anyone else for damages as a result of this incident? of yes, give name and address.) 18. if the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount? Dated at Dubuque, Iowa thisl I day of c.. ©6 , 20 l . (signature) (Print Name) (Rev. 1100 &7101) PO i CMR CLAIMS DEPARTMENT P.O. BOX 60770 OKLAHOMA CITY, OK 73146-0770 1-866-887-4066 CenturyLink- *****N'OTICE OF CLAIM***** Date: 10-13-2016 CERTIFIED MAIL, RETURN RECEIPT REQUESTED To: CITY OF DUBUQUE CITY CLERK FIRST FLOOR CITY HALL 50 W 13TH STREET DUBUQUE,IA 52001 CERTIFIED NIAIL# 7016 2070 0000 8837 0487 RE: Damage to CENTURYLINK Property CENTURYLINK Claim 615474 Num: Damage/Discovery Date: 08-12-2016 Damage Location: OLDE COUNTRY LN AND SPRING'FALL,DUBUQUE,IA Damage County: DUBUQUE Damage Amount: UNDETERMINED Dear Sir/Madam: Please be advised that CENTURYLINK Facilities sustained damage as a result of the negligent acts or omissions by employees or agents of CITY OF DUBUQUE . Investigation has revealed that on or about 08-12-2016 employees or agents of CITY OF DUBUQUE,THE CITY OF DUBUQUE WAS DOING HIGHWAY STREET EXCAVATION AND DAMAGED A CFNTURYLINK BURIED CABLE WITH A BACI,,'HOE in the area of OLDS COUNTRY LN AND SPRING VALL,DUBUQUE,IA, REQUEST FOR GOVERNMENTAL NOTICE FORM If your Governmental Entity requires the completion of its own form to complete proper notice,please forward a copy to the address listed above, Every good faith effort has been made to identify the proper office and address to perfect our notice. Please forward to your attorney, if misdirected, to contact us. Matters herein stated are alleged.on information and belief this pleader believes to be true. If there is insurance to cover this matter,kindly advise as to the name of the insurance company,its address and the claim number assigned. If you have any questions, or need additional information, please contact 1-800-321-4158 ext 8232. CAL V4 0 AR <J 15dip 3Sincerely, Chelsea Dongelewic C) _ZZ Pusq.1" .............. NOTARY(OCY P G, 0 CMR Claims DEPT Commission Expires